Lisburn Online Forms - Civil Marriage Approval

Title:

First Name:

Last Name:

E-Mail:

Main telephone number:

+

Other telephone number:

+

Street Number and Name:

City or Town:

Post Code:

Country:

Are you applying as a business or organisation?:

YesNo

Is your business registered in the UK with Companies House?:

YesNo

Is your business registered outside the UK ?:

YesNo

Registration Number:

Legal Status:

Legal Status -other:

Your position in the business:

Room/Location - Maximum Number:

Are you the occupier of the place?:

YesNo

If you answered 'No', and there is another occupier, please give their name(s) and address(es):

Name:

Occupation:

Private Address (including post code):

Telephone No:

+

Home/Mobile:

+

Name:

Occupation:

Private Address:

Telephone Number:

+

Home/mobile Number:

+

Do you have public liability insurance?:

YesNo

Insurance company:

Policy No:

Period of Cover:

Amount of Cover:

A current fire risk assessment:

Yes
No

Date of assessment:

Any relevant licences, e.g. under licensing or entertainment legislation?:

Yes
No

I declare that:

I have read and understood the information contained in this form, the 'Guidance Notes' for Applicants for Approval of a Place for Civil Marriages and Appendix A of the Guidance Notes

the place:

the place has no recent or continuing religious connection

permissions:

I have obtained all necessary permissions regarding use of and access to the place

I further declare that -:

if approval is granted, I will comply with the standard conditions and any local conditions (Appendix A) attached to that grant of approval.

Name:

Date (dd/mm/yyyy):

Fees:

Section 1 : Applicant Details
Title:
First Name:
Last Name:
E-Mail:
Main telephone number:	+
Other telephone number:	+
Street Number and Name:
City or Town:
Post Code:
Country:
Your Business
Are you applying as a business or organisation?:	YesNo
If you answer no please go to Section: 2
Is your business registered in the UK with Companies House?:	YesNo
Is your business registered outside the UK ?:	YesNo
Registration Number:
Legal Status:
Legal Status -other:
Your position in the business:
Marriage Rooms
Room/Location - Maximum Number:
Please ensure there is a separate confidential interview room conveniently located to the marriage room which is available to the Registrar
Are you the occupier of the place?:	YesNo
If you answered 'No', and there is another occupier, please give their name(s) and address(es):
Responsible Persons
Please give details of the person and is/her deputy who will be responsible on the day for arranging and co-ordinating the Marriage Ceremony and ensuring compliance with requirements and condtiions as attached (see Guidance Part 3.1)
Name:
Occupation:
Private Address (including post code):
Telephone No:	+
Home/Mobile:	+
Name:
Occupation:
Private Address:
Telephone Number:	+
Home/mobile Number:	+
Public Liability
Do you have public liability insurance?:	YesNo
Provide details of the policy
Insurance company:
Policy No:
Period of Cover:
Amount of Cover:
Additional Formalities
Please confirm whether the premises have:
A current fire risk assessment:	Yes No
Date of assessment:
Any relevant licences, e.g. under licensing or entertainment legislation?:	Yes No
Section 3: Declaration
I declare that:	I have read and understood the information contained in this form, the 'Guidance Notes' for Applicants for Approval of a Place for Civil Marriages and Appendix A of the Guidance Notes
the place:	the place has no recent or continuing religious connection
permissions:	I have obtained all necessary permissions regarding use of and access to the place
I further declare that -:	if approval is granted, I will comply with the standard conditions and any local conditions (Appendix A) attached to that grant of approval.
This application may be made by any person. If successful, the applicant will be the holder of the approval.
Name:
Date (dd/mm/yyyy):
Fees: